Bilateral medial rectus-levator inhibitory synkinesis: a case report and review of literature

Congenital oculopalpebral synkinesis is a rare phenomenon in which specific ocular movements induce paradoxical eyelid responses. Most reported cases involve excitatory forms, whereas inhibitory variants are distinctly uncommon. We present a 15-year-old boy with congenital right ptosis who demonstrated bilateral gaze-evoked synkinetic eyelid movements. In addition, paradoxical right upper lid retraction was observed on downgaze, and vertical lid twitching was evident in upgaze and lateral gazes. Ocular motility and pupillary reactions were normal, and no jaw-winking was present.